Citation Nr: 21030806 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 17-14 619 DATE: May 19, 2021 REMANDED Entitlement to service connection for a skin disorder, to include skin cancer, is remanded. Entitlement to service connection for a prostate disorder is remanded. REASONS FOR REMAND The Veteran served on verified active duty in the Army from October 1969 to August 1971, and from May 1976 to September 1983. He also had a period of active duty for training from July 1988 to December 1988 in the Army National Guard, as well as additional service in Army Reserve and Army National Guard. This matter is before the Board of Veterans' Appeals (Board) on appeal of an October 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO), that denied service connection for a skin disorder, to include skin cancer (listed as skin cancer) and for a prostate disorder (listed as a prostate condition). In January 2021, the Veteran appeared at a Board hearing before the undersigned Veterans Law Judge. The Veteran contends that he has a skin disorder, to include skin cancer, and a prostate disorder, that are related to service, to include as due to exposure to ionizing radiation and/or to exposure to Agent Orange. The Veteran specifically maintains that he was exposed to ionizing radiation and/or Agent Orange while serving at Johnston Island (Atoll) from February 1978 to February 1979. He also reports that he was exposed to chemical agents, including Lewisite, while serving as a chemical staff specialist and chemical officer during service. Alternatively, the Veteran having various recurrent skin problems since service. As noted above, the Veteran served on verified active duty in the Army from October 1969 to August 1971, and from May 1976 to September 1983. He also had a period of active duty for training from July 1988 to December 1988 in the Army National Guard, as well as additional service in Army Reserve and Army National Guard. The Veteran's DD Form 214, for his period of active duty from October 1969 to August 1971, lists his occupational specialty as a light vehicle driver. A DD Form 214, for his period of active duty from May 1976 to June 1980, lists the Veteran's occupational specialty as a chemical staff specialist for three years and nine months. A DD Form 214, for the Veteran's period of active duty from June 1980 to September 1983, lists his occupational specialty as a chemical officer for two years and ten months. A DD Form 214, for the Veteran's period of active duty for training in the Army National Guard, lists his occupational specialty as a supply and material management officer (training only). The Veteran's service personnel records indicate that he was stationed at Johnston Island (Atoll) from February 1978 to February 1979. Such records do not specifically show that he served in the Republic of Vietnam, or that he exposed to Agent Orange; ionizing radiation; and/or mustard gas/Lewisite. An August 2013 response from the National Personnel Records Center (NPRC), to a request to furnish a DD Form 1141/Records of Exposure to Radiation, indicates that the document or information is not a matter of record. An August 2013 response from the NPRC, to a request to furnish dates of the Veteran's service in the Republic of Vietnam, indicates that there was no evidence in the Veteran's file to substantiate any service in the Republic of Vietnam. An August 2013 response from the NPRC, to a request to furnish any documents showing exposure to herbicides, reflects that there were no records of exposure to herbicides. An August 2013 response from the NPRC, to a request to furnish any records of exposure to mustard gas/Lewisite, indicates that no document or information requested is a matter of record. A September 2013 response from the Department of the Navy, Naval Dosimetry Center, indicates that a review of the exposure registry, by name, service number, and social security number, revealed no reports of occupational exposure to ionizing radiation pertaining to the Veteran. The Naval Dosimetry Center reported that the information provided reflected the data in the Naval Exposure Registry for the Veteran. It was noted that because the official exposure record (DD 1141, NAVMED 6470/10 or equivalent document) was maintained in the Veteran's medical record, it would be prudent to compare that record with the report. The Veteran's available service treatment records indicate that he was treated for skin problems on multiple occasions. Such records do not specifically show that he was treated for skin cancer and/or for prostate problems. His service treatment records do include references to 1+ sugar and a transient albumin screen. A May 1978 treatment entry notes that the Veteran was seen for sunburn. The examiner reported that he was prescribed a spray. A November 1978 entry notes that the Veteran was seen for a rash on both legs. The examiner reported that it was probably a fungus between the buttocks and the left groin. The Veteran was provided with Triactin cream. A March 1979 objective examination report notes, as to skin and lymphatics, that the Veteran had multiple nevi. As to diagnoses, the examiner reported that the Veteran denied problems with alcohol or drug abuse, as well as any psychiatric problems. A February 1980 entry notes that laboratory results were secured and posted and refers to an evaluation for a "radiation exam." A May 1980 treatment entry notes that the Veteran complained of an infected finger for four days. He reported that he did not hurt his finger in any way. The assessment was a fungal infection. A January 1981 entry indicates that the Veteran complained of a fever for three days, and a skin lesions over his body, for one day. The assessment was viral exanthem. A subsequent January 1981 treatment entry reflects that the Veteran complained of a rash for four days. It was noted that the Veteran was seen earlier and diagnosed with a viral exanthem. The assessment was possible varicella. An additional January 1981 treatment entry notes that the Veteran was seen with multiple macules for six days, but with no new lesions. The assessment was multiple macules of unknown etiology. A February 1981 entry notes that the Veteran had a rash of an unknown etiology. It was reported that the Veteran also had an eruption of scleral erythema on the medial aspect of the right eye. The assessment was allergic conjunctivitis. On a medical history form at the time of a February 1981 examination, the Veteran checked that he had skin diseases. The reviewing examiner reported that the Veteran's skin disease was acne. A February 1981 objective examination report includes a notation that the Veteran's skin and lymphatics, as well as his genitourinary system, were normal. Post-service VA treatment records show that the Veteran was treated for variously diagnosed skin problems, including a skin neoplasm of uncertain behavior; basal cell carcinoma, with ulceration; and verrucous brown papules and macules over the trunk and upper extremities. Such records also show treatment for prostate problems, including benign prostatic hypertrophy (BPH); elevated prostate-specific antigens (PSAs); and adenoma of the prostate (robotic simple prostatectomy), with benign prostatic parenchyma, with stromal and glandular hyperplasia, and negative for dysplasia or malignancy. The Board notes that the Veteran has not been afforded VA examinations, as to his claims for service connection for a skin disorder, to include skin cancer, and for a prostate disorder. In light of the above, the Board finds that the Veteran should be afforded VA examinations, with the opportunity to obtain responsive etiological opinions, following a thorough review of the record, as to his claims for service connection for a skin disorder, to include skin cancer, and for a prostate disorder. Such examinations must be accomplished on remand. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Board observes, as discussed above, that the Veteran has been diagnosed with skin disorders, including basal cell carcinoma. The Board notes that basal cell carcinoma is a radiogenic diseases under 38 C.F.R. § 3.311(b)(2) and that it does not appear that the issue of entitlement to service connection for skin disorder, to include skin cancer, has been properly developed, to include obtaining a dose estimate pursuant to the provisions of 38 C.F.R. § 3.311(a)(1). Therefore, any such necessary development should also be undertaken on remand. Finally, the Board notes that the most recent VA treatment reports of record are dated in May 2017. The Board observes that as there are possible further VA treatment records that may be pertinent to the Veteran's claims, they should be obtained on remand. See Bell v. Derwinski, 2 Vet. App. 611 (1992) (VA medical records are in constructive possession of the agency, and must be obtained if the material could be determinative of the claim); see also Sullivan v. McDonald, 815 F.3d 786 (Fed. Cir. 2016) (VA has a duty to assist in obtaining sufficiently identified VA medical records or records of examination or treatment at non-VA facilities authorized by VA, regardless of their relevance). The matters are REMANDED for the following action: 1. Obtain copies of the Veteran's VA treatment records, which are not already in the claims folder, concerning his treatment for his claimed skin disorder, to include skin cancer, and for a prostate disorder, since May 2017. 2. Ask the Veteran to identify all other medical providers who have treated him for a skin disorder, to include skin cancer, and for prostate problems, since May 2017. After receiving this information and any necessary releases, obtain copies of the medical records which are not already in the claims folder. Document any unsuccessful efforts to obtain the records, inform the Veteran of such, and advise him that he may obtain and submit those records himself. 3. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service problems regarding his claimed skin disorder, to include skin cancer, and prostate disorder. The Veteran should be invited to submit lay evidence regarding whether he has had recurrent skin problems since service. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 4. The RO must develop the Veteran's claims, to specifically include his claim for service connection for a skin disorder, to include skin cancer, as necessary in accordance with the provisions of 38 C.F.R. § 3.311, to include obtaining a dose estimate. 5. Schedule the Veteran for an appropriate VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) to determine the nature onset and/or etiology of his claimed skin disorder, to include skin cancer. The claims file must be reviewed by the examiner. The examiner must diagnose all current skin disorders. The examiner must opine as to whether it is at least as likely as not that any currently diagnosed skin disorders are related to and/or had their onset during the Veteran's periods of service. The examiner must specifically acknowledge and discuss the Veteran's treatment for skin problems during service, competent reports by the Veteran of skin problems during and since service. 6. Schedule the Veteran for an appropriate VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) to determine the nature onset and/or etiology of his claimed prostate disorder. The claims file must be reviewed by the examiner. The examiner must diagnose all current prostate disorders. (Continued on the next page) The examiner must opine as to whether it is at least as likely as not that any currently diagnosed prostate disorders are related to and/or had their onset during the Veteran's periods of service. The examiner must specifically acknowledge and discuss any reports by the Veteran of symptoms he thought were due to prostate problems during service and since service. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. D. Regan, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.